A central focus of the debate on U.S. health care reform is using "comparative effectiveness research" to identify which health care services work best for which patients and under what circumstances. Now might be the right time for employee assistance programs (EAPs) to borrow a page from the comparative effectiveness research initiative and apply its basic principles.

While there is a marked increase in the number and types of EAPs available—from robustprogram models to more economical, phone or web-onlydelivery options—human resources is still faced with a simple, evergreen question: Do they work? There is no shortage of answers, which often cite end-user utilization rates, client referrals, or even employee click throughs on a web site to access resources. However, none of these truly addresses whether a specific EAP provider or service is effective. In other words, are employees achieving positive outcomes, and is the employer realizing the benefit—i.e., is an employee more productive at work because he or she is no longer suffering from depression, combating stress, dealing with substance abuse, or coping with marital conflict.

Rather than only including standard questions in a request for proposal (RFP), such as what is the return on investment (ROI) on the per-employee per-month cost for an EAP service, HR professionals should be asking providers what real outcomes they can expect from implementing services in their particularorganization. EAP providers, in turn, can respond by providing real data based on user experiences that is gleaned through administering surveys that ask employees to rate key workplace-related productivity issues, before and after utilizing EAP services. Applying scientific rigor to the survey process that historically has been used—albeit not to its fullest or best potential—can validate the real measure of an EAP’s effectiveness.

Historic Approaches

Historically, measurements of the effectiveness of an EAP in the workplace have not truly captured whether EAP vendors achieve results that are necessarily meaningful to employers. The most popular metrics for measuring EAP success fall short of this goal. For example:

• User satisfaction surveys. Good results, in terms of user satisfaction, do not imply or validate that an employer experienced improved workplace productivity. A number of variables can impact user satisfaction surveys—from whether the EAP provider was likable, to how many employees actually completed the survey.

• Case studies. First-hand, positive anecdotal accounts of an employee’s experience and results are valuable but imprecise and incomplete—especially when HR is charged with persuading management of the business value of an EAP. While case studies that recount an employee’s recovery from substance abuse or depression certainly have emotional appeal, they are not standard, quantifiable or reliable indicators of potential outcomes.

• Published studies. While published studies are a step in the right direction, they are problematic in that they often validate approaches rather than specific programs or services offered by an EAP provider under consideration. The question that HR should be asking is not whether EAPs are effective, but rather which ones are effective. An EAP service is not a generic or evidenced-based intervention; there are wide variations in program models and levels of quality.

That’s not to say that these measures are not useful in supporting the case for investing in EAP services. What HR needs to keep in mind is that these measures can be subjective and open to interpretation. Most important, they are not based on any scientific validation of workplace-related outcomes that obtain direct feedback from the employees that EAP services are intended to assist.

A New value Proposition

At the very core of any EAP is the understanding that employees with behavioral health and emotional well-being issues are as likely to struggle in their jobs as well as in their homes. Contemporary EAPs, however, have focused on being in the counseling business rather than in the business of improving workplace productivity using behavioral health expertise. From that perspective, the focus is on what services are being provided as opposed to what outcomes can be expected.

In other words, the focus should be on achieving change and not solely on how it was achieved. To use an analogy, consumers are only mildly interested in whether the service is better at one national retailer or another but are passionate about understanding the actual value of their purchase. And when it comes to selecting an EAP, the decision is often based on perceived value—typically a balance between cost and expected benefits and results.

Because most EAP outcome measures have not been viewed as highly persuasive or credible, price often becomes the sole value proposition. In theory, no organization would support paying for a service that does not produce positive workplace outcomes. The paradox is that without an effective monitoring tool for outcomes, there is no link between cost and expected results.

A workplace outcome-informed approach moves from a traditional focus on measuring processes (i.e., the average wait time to reach an EAP staff person by phone) and focuses on quantifying the impact of any EAP’s objective—producing results such as increased productivity. In short, HR should look to their EAP providers to implement a relevant outcome measurement tool that is workplace focused, appropriate to the services being provided, and able to document results.

A New Model for Measuring Outcomes

In addition to a commonly understood need for validity, reliability, objectivity and grounding in behavioral science, a good measurement tool must be able to detect change over time, not be burdensome (i.e., time consuming, lengthy) for the employee, and be tied directly to the outcomes that are expected (i.e., improved productivity). In short, such a tool needs to be brief and to the point—without losing its scientific validity. It should aim to marry scientific methodology with sound EAP practices by focusing on five key personal issues that directly affect workplace functioning: absenteeism, presenteeism, work engagement, life satisfaction and workplace distress.

Below is an example for measuring presenteeism where employees are asked to indicate the degree to which they agree with each of the statements for the past 30 days. The responses include the following: strongly disagree, somewhat disagree, neutral, somewhat agree, and strongly agree.

1. I had a hard time doing my work because of my personal problems.

2. My personal problems kept me from concentrating on my work.

3. Because of my personal problems I was not able to enjoy my work.

4. My personal problems made me worry about completing my tasks.

5. I could not do my job well because of my personal problems.

These questions are short and precise, requiring only three minutes to complete. An EAP provider then aggregates data based on the employees who responded to the survey, which is administered before and after the use of EAP services. The resulting comprehensive report not only analyzes the average change in employee behavior but also documents the EAP's impact on their participation and contributions in the workplace.

Automating Data Collection

Adding a technology component to the workplace outcome process can also enhance, simplify and expedite the survey method for employees, HR and the EAP. The survey process is flexible enough to be automated in a way best suited to the end user, for example:

• HR or the EAP vendor can build a survey process into an existing HR information system (HRIS).

• Survey software can be integrated and installed within an organization’s web portal.

• HR can purchase access to a secure outside web page (provided by the EAP vendor) so that employees can log in to respond to the survey.

Our experience shows the efficacy of such a workplace outcome process, which results in a better model for both HR and EAPs by:

• Providing documentation regarding the productivity payback that is specific to an EAP program.

• Advancing data management and reporting practices from activity reporting to the measurement of results.

• Differentiating an EAP program with empirical data rather than subjectivity and assumptions.

New Expectations

EAPs are a valuable resource that can help employees cope with critical issues in an increasingly complex and challenging world. And there is a relationship between an organization’s self interests and the ability for employees to work to their full potential. Marital and family problems, conflicts among co-workers and managers, depression, other psychological conditions, substance abuse, legal and financial issues, child and elder care needs—these are just some of the personal issues and problems that have a direct impact on employee well being and, as a result, an organization’s bottom line.

HR should expect more from their EAP providers in terms of having them validate the efficacy of their programs and services. In turn, ROI that is translated intoreal cost savings (i.e., productivity) can be calculated based on an integrated assessment model that focuses on quantitative measures (workplace outcome-based survey tools) and is supported by qualitative information (case studies).

This new approach of using a workplace outcome process finally answers that lingering question with scientific validity. Yes, EAPs do work and, most important, specific programs and services do deliver real benefits and results for both employees and employers.

Dave Sharar, PhD, ismanaging director of Chestnut Global Partners, the international employee assistance division of Chestnut Health Systems. Richard “Rik” Lennox, PhD, is a research psychologist and the vice president of Chestnut Global Partners division of commercial science.